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The dog wagged his tail. He didn't mind being back at a veterinary clinic. He liked meeting new people. When the veterinarian went to examine the wound, a few things seemed odd. For one, the owner was requesting pain medication, but not just any pain medication. She wanted a specific drug, an opioid. Secondly, the wound was surprisingly clean and sharp, not a typical cut or laceration received from a fence or a dog fight, not the expected wound given the history of “hurt while playing in yard." That's because the owner had injured her own dog so as to get a prescription from the veterinarian for a pain medication her dog would never be given but she would use herself.
During the opioid crisis, pets and veterinarians are occasionally being used as pawns. Pets, often dogs, will intentionally be harmed by drug-seeking owners. They may further claim that they need more medication because the original number of pills was inadequate or accidently washed down the sink. Sometimes they'll hurt the dog, then go from one clinic to the next requesting pain medications, removing sutures in between clinics as needed. This process of using a pet to gain something of value is referred to as malingering by proxy. The proxy is the pet. And the malingering can be seeking opioids, requesting other drugs such as anabolic steroids, antiseizure medications, or thyroid supplements, or wanting something else of value such as a crowd-sourcing fundraising account. Opioid-seeking behavior is enough of a problem that the FBI felt it necessary to send a general alert about the issue to veterinarians last year. In these instances, the persons doing the malingering are exploiting the animals for their own gain and with malicious intent.
On the other hand, there is Munchausen syndrome by proxy, also referred to as Factitious Disease Imposed on Another, and other names. This is a mental illness as defined by the Diagnostic and Statistical Manual of Mental Disorders. In these situations, a person invents or creates signs of disease in another, the proxy, for the sake of attention from the medical establishment or members of support groups. Oftentimes the proxy is a child, but it can also be a dependent adult or a pet. The idea is the same as malingering by proxy – using another to gain something – but the motivation is very different.
Munchausen syndrome by proxy (MSBP) is difficult to identify. Most importantly, veterinarians need to consider it as a possibility. Too often as veterinarians, we cannot imagine anyone harming their own pet. MSBP can be seen in a myriad of ways completely dependent upon what the owner is doing to invent or create the signs. Generally, it is the overall picture drawn by the history and signs that do not make sense with the physical exam and laboratory test results. It could include a history provided by the owner that cannot be verified easily by the veterinarian, such as a complaint of seizures or noise phobias at home. In other instances, the reported signs do not fit the exam findings, such as a dog with extreme weight loss purportedly due to nausea, vomiting, and anorexia that scarfs down food when given it and keeps it down without vomiting.
While it is difficult to diagnose, there are some signs consistent with potential MSBP. One is improvement to a pet's health once separated from the owner. Once the pet is no longer under control of the owner, it may recover from any harm inflicted upon it. Unfortunately another prominent sign of MSBP is a history of death in other animals under the same person's care, sometimes with similar clinical presentations. It is also possible for more than one proxy to be in a home, with signs of MSBP being inflicted on animals and children, for instance, so considering the health history of other pets in the home is important.
Fortunately, both Munchausen syndrome by proxy and malingering by proxy are rare. But knowing they are possibilities helps keep veterinarians alert to the dark side of human-animal relationships.
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